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Thien CI, Bessa VR, Miotto IZ, Samorano LP, Rivitti-Machado MC, Oliveira ZNPD. Hereditary epidermolysis bullosa: clinical-epidemiological profile of 278 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol 2024; 99:380-390. [PMID: 38403552 DOI: 10.1016/j.abd.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a group of rare hereditary diseases, characterized by fragility of the skin and mucous membranes. Epidemiological data on EB in Brazil are scarce. OBJECTIVES To describe epidemiological aspects of patients with EB diagnosed in the Dermatology Department of a tertiary hospital, from 2000 to 2022. METHODS An observational and retrospective study was conducted through the analysis of medical records. The evaluated data included clinical form, sex, family history, consanguinity, age at diagnosis, current age, time of follow-up, comorbidities, histopathology and immunomapping, presence of EB nevi and squamous cell carcinomas (SCC), cause of and age at death. RESULTS Of 309 patients with hereditary EB, 278 were included. The most common type was dystrophic EB (DEB), with 73% (28.4% dominant DEB, 31.7% recessive DEB and 12.9% pruriginous DEB). Other types were junctional EB with 9.4%, EB simplex with 16.5% and Kindler EB with 1.1%. Women accounted for 53% and men for 47% of cases. Family history was found in 35% and consanguinity in 11%. The mean age at diagnosis was 10.8 years and the current age was 26 years. The mean time of follow-up was nine years. Esophageal stenosis affected 14%, dental alterations affected 36%, malnutrition 13% and anemia 29%. During diagnostic investigation, 72.6% underwent histopathological examination and 92% underwent immunomapping. EB nevi were identified in 17%. Nine patients had SCC. Eleven patients died. STUDY LIMITATIONS Insufficient data included to medical records, loss to follow-up, and unavailability of genetic testing. CONCLUSIONS In this study, dystrophic EB predominated and the need for multidisciplinary care for comorbidities and complications was highlighted.
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Affiliation(s)
- Chan I Thien
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vanessa Rolim Bessa
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isadora Zago Miotto
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luciana Paula Samorano
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Chogani F, Parvizi MM, Murrell DF, Handjani F. Assessing the quality of life in the families of patients with epidermolysis bullosa: The mothers as main caregivers. Int J Womens Dermatol 2022; 7:721-726. [PMID: 35028371 PMCID: PMC8714583 DOI: 10.1016/j.ijwd.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is an uncommon group of inherited disorders characterized by skin blistering after friction or mechanical trauma. EB affects patients and their families physically, socially, and emotionally. Objective This study aimed to assess the family quality of life of these patients using the Family Dermatology Life Quality Index (FDLQI) questionnaire. Methods In this cross-sectional study, we enrolled caregivers of patients with EB registered at the Molecular Dermatology Research Center, affiliated with Shiraz University of Medical Sciences, up to 2020. Participants filled out a demographic data collection form and the FDLQI questionnaire. The data were analyzed using SPSS software, version 22. Results Overall, 80 participants, consisting of 65 mothers (81.2%) and 15 fathers (18.7%) as primary caregivers, were enrolled in this study. The average FDLQI score was 19.88 ± 4.71. The FDLQI scores of caregivers of patients with EB simplex was significantly lower than scores observed in those with other types of EB (p < .001). There was a significant positive association between the number of patients with EB in the family and FDLQI score (p = .049). FDLQI scores were lower in caregiving mothers who had a higher education (p < .001) and those who were employed (p < .001). Conclusion Family quality of life is affected in patients with EB. Families with lower socioeconomic status and unemployed caregivers require special attention. More studies are needed to determine the parameters involved in the quality of life of patients with EB and their families.
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Affiliation(s)
- Fatemeh Chogani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author.
| | - Dedee F. Murrell
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Rao R, Shetty VM. Utility of Immunofluorescence Antigen Mapping in Hereditary Epidermolysis Bullosa. Indian J Dermatol 2021; 66:360-365. [PMID: 34759393 PMCID: PMC8530072 DOI: 10.4103/ijd.ijd_131_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Epidermolysis bullosa (EB) is characterized by blisters and erosions on the trauma-prone areas of the body. It occurs as a result of mutation in the genes encoding structural proteins. Transmission electron microscopy (TEM) is considered the gold standard test in the laboratory diagnosis of EB. However, this test requires a lot of expertise and is not widely available. Immunofluorescence antigen mapping (IFM) is considered a suitable alternative with comparable sensitivity and specificity. However, there is paucity of studies analyzing the utility of IFM in the diagnosis of EB. Aims and Objectives To study the utility of IFM in the laboratory diagnosis of EB. Materials and Methods A cross-sectional study was conducted involving 179 biopsy specimens of patients with EB. IFM was carried out using a panel of monoclonal antibodies against K14, laminin 332, type IV collagen, and type VII collagen. Results Diagnosis of EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB) was made in 104, 28, and 26 biopsy specimens, respectively. The overall concordance rate was 41.3% with higher concordance rates in EBS. Conclusion The present study is conducted to assess the efficacy of IFM in the diagnosis of EB with large sample size. Our study serves to establish IFM as an important tool in the diagnostic armamentarium of EB as the prognosis mainly rests on diagnosing the type of EB.
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Affiliation(s)
- Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Varsha M Shetty
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mariath LM, Kiszewski AE, Frantz JA, Siebert M, Matte U, Schuler-Faccini L. Gene panel for the diagnosis of epidermolysis bullosa: proposal for a viable and efficient approach. An Bras Dermatol 2021; 96:155-162. [PMID: 33640189 PMCID: PMC8007490 DOI: 10.1016/j.abd.2020.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background Epidermolysis bullosa is characterized by cutaneous fragility and blistering. Historically, diagnosis is achieved by immunofluorescence mapping or transmission electron microscopy, both involving biopsy procedures. Genetic analysis, especially through next-generation sequencing, is an important tool for the diagnosis of this disease. In Brazil, access to diagnostic methods is limited, and consequently, most patients do not have an accurate diagnosis. Diagnosis allows the indication of prognosis and genetic counselling of the patient. Objectives To evaluate the cost-effectiveness of a gene panel compared to immunofluorescence mapping and transmission electron microscopy by analyzing its benefits, limitations, and economic aspects. Methods The gene panel included the 11 main genes associated with epidermolysis bullosa. The techniques were compared, assessing the average cost, advantages, and limitations, through a price survey and literature review. Results Both immunofluorescence mapping and transmission electron microscopy require skin biopsy, are dependent on the investigator’s expertise, and are subject to frequent inconclusive results. The gene panel is effective for the conclusive diagnosis of epidermolysis bullosa, presents high efficiency and accuracy, is economically feasible, and excludes the need for biopsy. The gene panel allows for prognosis, prenatal genetic diagnosis, and genetic counseling. Study limitations It was not possible to find laboratories that perform transmission electron microscopy for epidermolysis bullosa diagnosis in Brazil. Conclusion This study supports the gene panel as the first-choice method for epidermolysis bullosa diagnosis.
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Affiliation(s)
- Luiza Monteavaro Mariath
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Elisa Kiszewski
- Dermatology Section, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Dermatological Pediatrics Section, Hospital da Criança Santo Antônio, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jeanine Aparecida Frantz
- School of Medicine, Universidade Regional de Blumenau, Blumenau, SC, Brazil; DEBRA Brasil, Blumenau, SC, Brazil
| | - Marina Siebert
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ursula Matte
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lavínia Schuler-Faccini
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, RS, Brazil.
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Quality of life in people with epidermolysis bullosa: a systematic review. Qual Life Res 2020; 29:1731-1745. [DOI: 10.1007/s11136-020-02495-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 12/12/2022]
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Christofolini DM, Ceroni JRM, Soares GG, Lamy GB, Calvo ACN, Santos TAD, Sonoda BDB, Bianco B, Barbosa CP. Reproductive alternatives for patients with dystrophic epidermolysis bullosa. EINSTEIN-SAO PAULO 2019; 17:eRC4577. [PMID: 31215591 PMCID: PMC6559778 DOI: 10.31744/einstein_journal/2019rc4577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022] Open
Abstract
Epidermolysis bullosa describes a group of skin conditions caused by mutations in genes encoding proteins related to dermal-epidermal adhesion. In the United States, 50 cases of epidermolysis bullosa per 1 million live births are estimated, 92% of which classified as simplex, 5% dystrophic, 1% junctional and 2% non-classified. Dystrophic epidermolysis bullosa is associated with autosomal, dominant and recessive inheritance. Epidermolysis bullosa causes severe psychological, economic and social impacts, and there is currently no curative therapy, only symptom control. Embryonic selection is available for epidermolysis bullosa patients in order to prevent perpetuation of the condition in their offspring.
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Callegaro EDAC, Nappi F, Lazzarini R, Lellis RF. Pretibial dystrophic epidermolysis bullosa. An Bras Dermatol 2017; 92:126-128. [PMID: 29267469 PMCID: PMC5726700 DOI: 10.1590/abd1806-4841.20175952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/01/2016] [Indexed: 12/02/2022] Open
Abstract
Epidermolysis bullosa is a group of mechano-bullous genetic disorders caused by
mutations in the genes encoding structural proteins of the skin. Dystrophic
epidermolysis bullosa is caused by mutations in the COL7A1 gene encoding
collagen VII, the main constituent of anchoring fibrils. In this group, there
are autosomal dominant and recessive inheritances. The pre-tibial form is
characterized by the presence of blisters, milia, atrophic scars and lesions
similar to lichen planus. The diagnosis is clinical and laboratory and subtypes
are distinguished by means of immunohistochemical and ultrastructural studies,
in addition to genetic differentiation. Electron microscopy and immunomapping
are used in the diagnosis.
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Affiliation(s)
| | - Flavio Nappi
- Department of Dermatology, Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Rosana Lazzarini
- Department of Dermatology, Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
| | - Rute Facchini Lellis
- Department of Dermatopathology of the Department of Anatomic Pathology, Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil
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Zidorio APC, Dutra ES, Leão DOD, Costa IMC. Nutritional aspects of children and adolescents with epidermolysis bullosa: literature review. An Bras Dermatol 2015; 90:217-23. [PMID: 25830992 PMCID: PMC4371671 DOI: 10.1590/abd1806-4841.20153206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/06/2014] [Indexed: 12/13/2022] Open
Abstract
Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however,
all others systems are influenced. The nutritional care of children and adolescents
with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are
increased due to the disease's metabolism, burdening the immune system and
cicatrization process, symptoms caused by the disease hinder the intake and adequate
absorption of nutrients, which may result in inadequate growth and development.
Because this is a rare disease, there are few professionals who know the
characteristics of both the clinical evolution and nutritional and dietary
treatments. This literature review discusses the latest knowledge on energy and
specific nutrient requirements to the dietary treatment and monitoring of children
and adolescents with Epidermolysis Bullosa.
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Almeida HLD, Monteiro L, Marques e Silva R, Rocha NM, Scheffer H. Scanning electron microscopy of a blister roof in dystrophic epidermolysis bullosa. An Bras Dermatol 2014; 88:966-8. [PMID: 24474107 PMCID: PMC3900349 DOI: 10.1590/abd1806-4841.20131743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 06/20/2012] [Indexed: 11/21/2022] Open
Abstract
In dystrophic epidermolysis bullosa the genetic defect of anchoring fibrils leads to cleavage beneath the basement membrane, with its consequent loss. We performed scanning electron microscopy of an inverted blister roof of a case of dystrophic epidermolysis bullosa, confirmed by immunomapping and gene sequencing. With a magnification of 2000 times a net attached to the blister roof could be easily identified. This net was composed of intertwined flat fibers. With higher magnifications, different fiber sizes could be observed, some thin fibers measuring around 80 nm and thicker ones measuring between 200 and 300 nm.
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Affiliation(s)
- Hiram Larangeira de Almeida
- Federal University of Pelotas, PelotasRS, Brazil, PhD, Assistent Professor of Dermatology - Federal University of Pelotas and Catholic University of Pelotas (UFPel) - Pelotas (RS), Brazil
| | - Luciane Monteiro
- Postgraduate Program in Health, Catholic University of Pelotas, PelotasRS, Brazil, Postgraduate Program in Health, Catholic University of Pelotas (UCPel) - Pelotas (RS), Brazil
| | - Ricardo Marques e Silva
- Laboratory for Electron Microscopy, Federal University of Pelotas, PelotasRS, Brazil, Laboratory for Electron Microscopy, Federal University of Pelotas (UFPel) - Pelotas (RS), Brazil
| | - Nara Moreira Rocha
- Electron Microscopy Laboratory, Empresa Brasileira de Pesquisa Agropecuária, PelotasRS, Brazil, Electron Microscopy Laboratory, Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA-CPA-CT) - Pelotas (RS), Brazil
| | - Hans Scheffer
- Human Genetics Department, DNA Diagnostics Division, Medical Center, Radboud University Nijmegen, Netherlands, PhD - Human Genetics Department, DNA Diagnostics Division, Radboud University Nijmegen Medical Center, Netherlands
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Almeida HLD, Rossi G, Karam OR, Rocha NM, Silva RME. Comparative scanning electron microscopy of bullous diseases. An Bras Dermatol 2014; 89:347-50. [PMID: 24770520 PMCID: PMC4008074 DOI: 10.1590/abd1806-4841.20142161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/22/2012] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to compare scanning electron microscopy findings of the
blister roof in three distinct bullous diseases: one intraepidermal acantholytic
(pemphigus foliaceus); one due to hemidesmosomal dysfunction (bullous pemphigoid);
and one secondary to anchoring fibril dysfunction - type VII collagen (dystrophic
epidermolysis bullosa). In pemphigus foliaceus, acantholytic phenomena were readily
demonstrated. In bullous pemphigoid, the epidermis had a solid aspect. In dystrophic
epidermolysis bullosa a net was seen in the blister roof.
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Affiliation(s)
| | - Gabriela Rossi
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Nara Moreira Rocha
- CPA-CT, Empresa Brasileira de Pesquisa Agropecuária, Pelotas, RS, Brazil
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Boeira VLSY, Souza ES, Rocha BDO, Oliveira PD, Oliveira MDFSPD, Rêgo VRPDA, Follador I. Inherited epidermolysis bullosa: clinical and therapeutic aspects. An Bras Dermatol 2014; 88:185-98. [PMID: 23739692 PMCID: PMC3750879 DOI: 10.1590/s0365-05962013000200001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/24/2012] [Indexed: 12/20/2022] Open
Abstract
Inherited epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders
that present with skin and, in some cases, mucosal fragility, predisposing patients
to the development of blisters and/or erosions after minimal trauma or friction.
Children with a recurrent history of these kinds of lesions or neonates that present
them in the absence of another reasonable explanation should be investigated.
Diagnosis must be based on clinical and histopathological findings. To date,
management of inherited EB basically consists in avoiding traumas that trigger
lesions, as well as preventing infection and facilitating healing of the wounds with
the systematic use of bandages.
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Almeida HLD, Heckler GT, Fong K, Lai-Cheong J, McGrath J. Sporadic Kindler syndrome with a novel mutation. An Bras Dermatol 2013; 88:212-5. [PMID: 24346923 PMCID: PMC3875998 DOI: 10.1590/abd1806-4841.20132173] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 10/23/2013] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 28-year-old woman with Kindler syndrome, a rare form of
epidermolysis bullosa. Clinically, since childhood, she had widespread pigmentary
changes in her skin as well as photosensitivity and fragility of the skin and mucous
membranes. The mucosal involvement led to an erosive stomatitis as well as
esophageal, anal and vaginal stenoses, requiring surgical intervention. The diagnosis
of Kindler syndrome was confirmed by DNA sequencing with compound heterozygosity for
a nonsense/frameshift combination of mutations (p.Arg110X; p.Ala289GlyfsX7) in the
FERMT1 gene.
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Affiliation(s)
| | | | - Kenneth Fong
- St John's Institute of Dermatology Research Laboratories, London, England
| | - Joey Lai-Cheong
- St John's Institute of Dermatology Research Laboratories, London, England
| | - John McGrath
- St John's Institute of Dermatology Research Laboratories, London, England
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Almeida HLD, Monteiro LMA, Goetze FM, Silva RME, Rocha NM. Clinical variability in dystrophic epidermolysis bullosa and findings with scanning electron microscopy. An Bras Dermatol 2012; 87:127-30. [PMID: 22481662 DOI: 10.1590/s0365-05962012000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/20/2011] [Indexed: 11/21/2022] Open
Abstract
In dystrophic epidermolysis bullosa, the genetic defect of anchoring fibrils leads to cleavage beneath the basement membrane and its consequent loss. A 46 year-old female patient presented blisters with a pretibial distribution associated with nail dystrophy. Her two children had hyponychia and anonychia, which affected all toe nails and the thumb, forefinger and middle finger. DNA sequencing identified in exon 75 of COL7A1 gene a pathologic mutation: c.6235G>A (p.Gly2079Arg). Immunomapping of a blister demonstrated collagen IV (basal membrane) in the blister roof and collagen VII in its floor, confirming dystrophic epidermolysis bullosa. Scanning electron microscopy of an inverted blister showed net-forming collagen attached to the blister roof . The variability found in this family has already been reported and confirms, on a clinical basis, the nail subtype as a dystrophic variant.
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